IRANIAN JOURNAL OF ENDOCRINOLOGY AND METABOLISM (IJEM)
Year:2002 | Volume:4 | Issue:1(SN 13)|Papers Count:12

Introduction: Many studies have been conducted to compare WHO and ADA criteria for detection of new diabetic patients. This study aims to compare these two criteria in a community-based epidemiological survey in an urban population of the Tehran, Iran. Materials and methods: We studied 3870 men and 5359 women aged 20 years and over, participating in Tehran Lipid and Glucose Study (TLGS). Those with known diabetes were excluded. Blood samples were taken after 12-14 hours’ overnight fast and 2 hours after taking 75gr of glucose orally. Prevalence of showed tolerance categories and the level of agreement (k statistic) were obtained using WHO and ADA criteria. Results: Using WHO criteria,6.0% (0.95% CI:5.5-6.5) had type-2 diabetes and 13.0% (12.3-13.7) had IGT (Impaired glucose tolerance). Using ADA, 3.3% (2.9-3.7) had type-2 diabetes and 4.8% (4.4-5.2) had IFG (Impaired fasting glucose) (p<0.05 and <0.001) for diabetes and IGT respectively. 7355 (84%) should concordant results with both criteria. Among 7105 normal subjects by WHO, 153 (2.2%) had IFG or diabetes by ADA, whereas among 8068 normal subjects according to ADA, 1116 (13.8%) had IGT or diabetes by WHO. The level of agreement (k statistic) between two criteria was 35% (p<0.001). Sensitivity and specificity of ADA criteria were 45.5 and 99.8%, respectively, taking WHO as the gold standard. Conclusion: Our data shows low agreement between WHO and ADA diagnostic criteria for detection of diabetes. Patients with unknown diabetic IGT are detected more frequently using WHO criteria.

Introduction: This study was designed to investigate the relationship between food habits and fasting blood glucose and glycosylated hemoglobine in petients with type 2 diabetes. Materials and methods: In a descriptive analytic study, type 2 diabetic patients over 30 years old, referred to Endocrine and Metabolism Research Center, were studied. Using the Passim and Bennett questionnaire, 34 different sorts of foods were divided into 3 groups: Foods eaten over 3 times a week, 1-3 times a week, and less than 1 time a week. Glycosylated hemoglobin (HbA1c) and fasting blood sugar (FBS) were measured. Results: The results were analysed using factor analysis, multiple regression and t-student methods in SPSS package and p<0.05 was statistically significant. There were 86 participants in this study (31 males and 55 females). The results showed that raw vegetables and fresh fruits were conversely related with HbA1c and raw vegetables with FBS. Also, veal and lamb meat, potato, lard and sucrose were related with FBS. Conclusion: We conclude that fruits and vegetables are useful for the control of diabetes and the prevention of diabetic complications. Also, it seems that the use of red meat, potato, lard and sucrose for diabetic patients needs to be limited.

Introduction: Formation of end-glycation products is one of the major causes of chronic diabetes complications. Although there is some evidence that vitamin C inhibits protein and hemoglobin glycosylation in healthy individuals, its effect on diabetic patients is still being debated. The aim of this clinical trial was to examine the pharmacologic effect of vitamin C on hemoglobin A1c (HbA1c) and fasting blood sugar (FBS plasma levels) in diabetic patients. Materials and Methods: For this purpose 53 (8 male, 45 female) type 2 diabetic patients who had FBS <250 mg/dL were selected for the study. The age range was 37-70 years with a mean of 52.8±10 years. Patients were given 1g vitamin C per day for 3 months. Changes in body weight, FBS, and HbA1c level were compared before and after therapy. FBS was measured by the enzymatic glucose oxidase method (normal range: 75-110 mg/dL) and HbA1c was assayed according to WHO calorimetric method with a normal range of 2.5-4 μmol/g Hb%. Results: The mean FBS level was 185±43.9 mg/dL at the beginning and 176.5± 48.7 mg/dL at the end of study. The mean FBS level changes during study was -8.9±40.2 mg/dL, which was not significant (p>0.05). The mean HbA1c level at the beginning was 4.9± 0.9, at the end 4.7±1, with a mean change of range -0.2±0.9 µmol/gHb%, which was not significant (p>0.05). Also mean body weight changes were not significant during study (p>0.05). The decrease in level of HbA1c from 1 to 15%, shown in 49% of patients was related significantly to decreased weight (p<0.001) and in the 26% with most decreased HbA1c levels (10-15%), it was related also to decreased FBS (p<0.05). Conclusion: According to these results, decreased HbA1c level was due to weight loss and better glucose control rather than vitamin C effects. Therefore vitamin C consumption for prevention of type 2 diabetes complications by inhibition of protein glycosylation is not recommended.

Introduction: Gestational diabetes mellitus (GDM) is a disorder of carbohydrate metabolism, first diagnosed during pregnancy. This study aims to determine the prevalence of GDM in young pregnant women. Materials and Methods: Two thousand one hundred pregnant women referred to five university hospital clinics, 1043 under 25 years old. Previously known diabetic patients were excluded from the study. Universal screening was performed with a 50 gram 1-hour glucose challenge test (GCT). Those with plasma glucose levels ≥ 130 mg/dL underwent a 100 gram 3-hour glucose tolerance test to diagnose GDM according to Carpenter and Coustan criteria. Family and obstetric histories were taken followed by a complete physical examination. Results: Among the 1209 young pregnant women (mean age±SD 20.97± 2.1, years), 27 (2.23%) were detected to have GDM (mean age ±SD 21.11±1.85 years). Of the GDM patients, 14.81% were obese, 22.22% had glycosuria. Among GDM patients, 16 (59.25%) did not have any recognized risk factors.Conclusion: High prevalence of gestational diabetes mellitus in young Iranian pregnant women may suggest revision of the appropriateness of criteria for GDM screening.

Introduction: None of the current available long-term therapies for thyrotoxicosis is ideal, and the choice for each patient must be made individually. The purpose of the present study is to compare the two choices of treatment, the radioiodine and antithyroid drug therapy. Materials and Methods: The study population were thyrotoxic patients treated in Shaheed Beheshti Hospital of Babol between April 1997 to May 2000. Diagnosis of thyrotoxicosis was based on the clinical features and assessment of serum TSH, T4 and T3 levels. Patients with thyroiditis and patients non compliant to regular treatment were excluded. Standard antithyroid drug therapy was started for all patients and continued until the occurence of remission, then tapered off and discontinued. Patients unresponsive to at least six months of drug therapy or patients with disease recurrence after, at least, a three month remission period, were treated with 8-15 mci, of radioiodine and continuation of antithyroid therapy until reaching a euthyroid state. All patients were followed during the treatment period and for at least one year after the beginning of remission. Results: 30 patients (20 females, 10 males) with a mean age of 46±11 years and 44 patients (22 females, 22 males) with a mean age of 37±14 were treated by radioiodine and antithyroid drugs. The disease duration in the two age groups was 14±33 and 10.5±15 months respectively (p=NS), and causes of thyrotoxicosis in the two groups were: Graves’ disease in 63% and 79.5%, toxic multinodular goiter in 27% and 11.5% (p<0.05), toxic nodular goiter in 10 and 9% of patients. After a mean follow-up of 19.7±21 months, 60% of patients achieved remission by radiodine and 40% became hypothyroid, whereas 45% of patients achieved remission by antithyroid drugs and 55% remained hyperthyroid for as long as 28±19 months. The duration of antithyroid drug therapy in each group was 3.3±4.8 and 13.3±8.3 months, respectively. No drug reaction or recurrence was observed during the remission period of 17.5±19 and 21±18 months. Conclusion: On a short term basis, the outcome of thyrotoxicosis for remission is similar either by radioiodine or antithyroid drug therapy, but development of hypothyroidism in the former and persistance of hyperthyroid state in the latter, gives radioiodine therapy priority.

Introduction: Hypothermia has biological and physiological effects on the endorine system. The present study was undertaken to evaluate the effects of hypothermia on the thyroid function of rats. Material and Methods: Serum total T4, total T3, TSH, free T4 (FT4) and free T3 (FT3) were investigated in ten male albino Wistar rats (with an average age of 8 months) The rats were exposed to hypothermia for two hours. The body temperature was kept constant at 25oC. Serum thyroid hormone levels were measured before and immediately after hypothermia and then it was measured every 24 hours for four days. Results: The data showed variations of thyroid hormone during hypothermia. In comparison to basal level (before hypothermia) TSH level changed during the period of hypothermia but it was not statistically significant. T4, FT4 and FT3 decreased after hypothermia and it was statistically significant (p<0.002), while T3 increased significantly (p<0.005) during exposure to hypothermia after 48 hrs. The largest decrease was in FT4 and FT3. The decreasing level of FT4 did not reach the basal level even 96 hours after hypothermia. The concentration of T4 was statistically significant until 48 hours postexposure. It increased after 72 hours but did not reach the basal level. Conclusions: Hypothermic exposure had opposite effects on total thyroid hormones and their free fractions. The results of this study showed a decrease in thyroid gland activity and hypothalamo-hypophyseal axis, with a more pronounced effect on the thyroid gland.

Objectives: Following bone marrow transplantation (BMT), life expectancy of many patients increases , necessitating medical follow up, especially function of the endocrine gland. Previous studies have showed endocrine dysfunctions are caused not only by total body irradiation, but also by cytotoxic drug conditioning regimens. Materials and Methods: 46 patients (12 F, 34 M), aged 1.5-49 years were evaluated for thyroid (T3, T4, TSH, T3RU, FTI, Anti Tg-Ab, Anti TPO-Ab), parathyroid (Ca, Alkp, PTH), gonad function (LH, FSH, E2, progesterone in females and semen analysis in males) and function of β-cells of pancreas by O.G.T.T (in 12 major thalassemic patients) before and 3, 6, 12, 24 months after B.M.T, by the “Little” Busulfan-cyclophosphamide conditioning regimen. Results: There are no differences between results of clinical examinations and laboratory, tests of pre and post B.M.T function of thyroid or parathyroid and calcium metabolism. The function of leydig cells was normal in 11 adult men (G5P5) before and 3, 6, 12 months after B.M.T, but injury of germinal cells (oligo or azo spermia) before and 12 months after B.M.T was seen. There is no relation between FSH and injury of germinal cells. Development of puberty was normal in 5 boys (G2P2 or G3P3) before and one year after B.M.T. primary hypogonadism was induced in 4 females (B5P5) after B.M.T. In one 14 year-old female, regular menstruation continued 2 years after B.M.T. In one girl (P1B1 before BMT) ovarian failure developed 12 months after BMT. Function of β-cells in thalassemic patients (Ferritin>1000 before BMT) before and after BMT was normal. Conclusion: One year after B.M.T, only the chemotherapy conditioning regimen did not affect function of thyroid or parathyroid gland, but ovarian failure and germinal cells injuries developed (without effect on leydig cell). BMT had no effect on the function of β-cells of pancreas.

Precocious pubarche, characterized by appearance of pubic hair before 8 years in girls and 9 years in boys, is most often a benign condition secondary to the early maturation of the adrenal cortex which is called precocious adrenarche. However, Precocious pubarche may be a manifestation of nonclassical adrenal hyperplasia, especially 21-hydroxylase deficiency and 3β-hydroxysteroid dehydrogenase deficiency, which require early diagnosis and special treatment. Today nonclassical 3?-hydroxysterioid dehydrogenase deficiency (NC3HSD) is being diagnosed with increasing frequency as a cause of precocious pubarche. In this article we report an 8- year -old boy with precocious pubarche and rapid growth progressive bone maturation (without other signs of puberty) due to NC3HSD. The diagnosis was based on significantly increased level of DHEA and ratios of 17-hydroxypregnenolon to 17-hydroxyprogesterone and of dehydroepiandrosterone to androstenedione after administration of ACTH. Thus, in spite of the fact that premature adrenarche is the most common cause of precocious pubarche, ACTH test must be performed for subjects in whom a rapid growth and progressive bone maturation is observed to diagnose NC3HSD that requires special treatment.

Postpartum autoimmune thyroid disease is a relatively common but unrecognized endocrinologic disorder. The incidence varies geographically but occurs in approximately 5% to 10% of women during the postpartum period. It is strongly associated with a positive titer of anti TPO antibodies, indicating an autoimmune process. Clinical manifestations can vary from extremely subtle to overt, and rang from thyrotoxicosis to hypothyroidism. Long term follow-up, reveals a high rate of recurrence and marked increased risk for permanent hypothyroidism. In this article the process of the disorder, treatment and follow-up will be discussed.

Introduction: The control of hyperlipidemia is vital in CVD patients. Omega-3 fatty acids (O3FAs) have desirable effects on serum triglycerides (TG), thrombosis and arrhytharrythmia but lead to an increase in serum LDL and apo B as well. Vitamin C can induce LDL receptor activity of the liver and catabolize LDL particles. To determine the effects of adminstration of O3FAs, Vitamin C, and O3FAs+ vitamin C on serum levels of LDL, apo B, other serum lipids and compare these effects, the present study was performed at the Tehran University of Medical Sciences from 2000 to 2001. Material and Methods: In a double-blind, placebo controlled trial with parallel design, 68 hyperlipidemic patients [total cholestrol (TC) and triglycerides (TG) greater than 200 mg/dL] were randomly assigned to receive daily 500 mg vitamin C, 1g O3FAs, 500 mg vitamin C + 1 g O3FAs or placebo (control) for 10 weeks. Fasting blood samples were collected at the beginning and at the end of this period. TG, TC, LDL, HDL were enzymatically, vitamin C calorimetrically, apo B and apo A-I immunoturbidometrically measured. For statistical analysis, ANOVA, paired t test, Chi square and repeated measurement ANOVA were used. Results: There were no significant changes during the study in pattern of food consumption, socioeconomic and anthropometric indices. There was a significant increase in the blood vitamin C level at the end of the study, in comparison to the initial value in vitamin C (p=0.001) and vitamin C + O3FAs (p=0.02) groups. There was a significant difference in the serum TC (p=0.004), apo B (p=0.005) and decrease in apo A-I/apo B (p=0.05) at the end of the study in comparion to the initial values as well as a significant increase in blood vitamin C compared to the control group (p=0.01). At the end of the study in O3FAs group, the TG/HDL and apo B respectively had significant decreases as compared to the beginning (p=0.04, p=0.05, respectively) and TG/HDL of this group at the end of the study significant decereased compared to the control group (p=0.04). There was no significant difference in HDL, LDL, apo A-I and LDL/HDL during the study in each group. Conclusion: Simultaneous administration of O3FAs and vitamin C had no beneficial effect on the lipid profile of hyperlipidemic patients, but 1 g purified O3FAs daily for 10 weeks is a beneficial supplement for decreasing TG and TG/HDL without any increase in LDL and apo B. 500 mg vitamin C for more than 10 weeks possibly decreases TC and apo B significantly in hyperlipidemic patients as compared to the control group.